Provider Demographics
NPI:1245341064
Name:CENTER FOR DYNAMIC WELL BEING INC
Entity type:Organization
Organization Name:CENTER FOR DYNAMIC WELL BEING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-826-1901
Mailing Address - Street 1:7700 CONGRESS AVE
Mailing Address - Street 2:1131
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1352
Mailing Address - Country:US
Mailing Address - Phone:561-826-1901
Mailing Address - Fax:561-826-1902
Practice Address - Street 1:7700 CONGRESS AVE
Practice Address - Street 2:1131
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1352
Practice Address - Country:US
Practice Address - Phone:561-826-1901
Practice Address - Fax:561-826-1902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW76301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9015Medicare PIN